The rationale for the design of control groups in tuina clinical trial is the foundation for rigorously validating the effectiveness and safety of this therapy. This article reviewed the current state of the design of tuina placebo in control groups of clinical trials， pointed out the necessity of setting up tuina placebo in clinical trials of tuina， analyzed the challenges in implementing blinding of tuina manipulation， and concluded that tuina placebo is still challenged by the placebo effect， the diversification of tuina manipulation but the lack of standardization， and the difficulty of implementing blinding due to the high level of public awareness of tuina. This article also summarized the design of placebo manipulation in three types of clinical trials， including spinal manipulation， acupressure， and paediatric tuina， and proposed four strategies for designing placebo tuina manipulation-controlling placebo effects， developing operational standards for placebo tuina manipulation， ensuring the rigor of blinding implementation， and applying new technologies to enhance the standardization and blinding capacity of placebo tuina methods. So the article is aimed at improving the methodological quality of tuina clinical trial designs， and promoting the standardization and scientificity of tuina clinical trial design.

OBJECTIVE: To observe the effect of electroacupuncture at "Sishencong" (EX-HN1) and "Fengchi" (GB20) on hippocampal neuronal ferritinophagy mediated by the nuclear receptor coactivator 4 (NCOA4)/ferritin heavy chain 1 (FTH1) signaling pathway in vascular dementia (VD) rats, and to explore the potential mechanisms of electroacupuncture for VD. METHODS: A total of 60 male rats of SPF grade were randomly divided into a blank group (12 rats), a sham surgery group (12 rats) and a modeling group (36 rats). In the modeling group, the modified 4-vessel occlusion method was used to establish the VD model. The 24 successfully modeled rats were randomly divided into a model group and an electroacupuncture group, with 12 rats in each group. In the electroacupuncture group, electroacupuncture was applied at left and right "Sishencong" (EX-HN1), and bilateral "Fengchi" (GB20), with continuous wave, in frequency of 2 Hz and current intensity of 1 mA, 30 min a time, once daily for 21 consecutive days. The learning and memory abilities were assessed using the Morris water maze test before modeling, after modeling and after intervention, as well as the novel object recognition test after intervention. After intervention, the neuronal morphology in the hippocampus was observed by Nissl staining; the iron deposition was observed by Prussian blue staining; the reactive oxygen species (ROS) level was detected by dihydroethidium (DHE) fluorescence staining; the levels of iron, malondialdehyde (MDA) and superoxide dismutase (SOD) in the hippocampal tissue were measured by the colorimetric assay, TBA method, and WST-1 method, respectively; the positive expression of NCOA4, FTH1 and glutathione peroxidase 4 (GPX4) was detected by immunohistochemistry; the protein expression of NCOA4, FTH1, GPX4, and the ratio of microtubule-associated protein 1 light chain 3B (LC3B) Ⅱ/Ⅰ in the hippocampus were detected by Western blot. RESULTS: Compared with the sham surgery group, in the model group, the escape latency was prolonged, and the number of platform crossings reduced (P<0.01), the recognition index (RI) was decreased (P<0.01); the hippocampal neurons displayed a blurred laminar structure, disorganized cellular arrangement, and the number of Nissl bodies was decreased (P<0.01); the percentage of iron deposition area in the hippocampus was increased (P<0.01); in the hippocampus, the levels of ROS, iron, MDA, and the protein expression of NCOA4, as well as the LC3B Ⅱ/Ⅰ ratio were increased (P<0.01), the SOD level, and the protein expression of FTH1 and GPX4 were decreased (P<0.01). Compared with the model group, in the electroacupuncture group, the escape latency was shortened and the number of platform crossings was increased (P<0.01), the RI was increased (P<0.01); the hippocampal neurons exhibited more regular morphology, better-organized cellular structure, and the number of Nissl bodies was increased (P<0.05); the percentage of iron deposition area in the hippocampus reduced (P<0.01); in the hippocampus, the levels of ROS, iron, MDA, and the protein expression of NCOA4, as well as the LC3B Ⅱ/Ⅰ ratio were decreased (P<0.01, P<0.05), the SOD level, and the protein expression of FTH1 and GPX4 were increased (P<0.01). CONCLUSION Electroacupuncture at "Sishencong" (EX-HN1) and "Fengchi" (GB20) can improve learning and memory abilities in VD rats, and its mechanism may be associated with the regulation of the hippocampal NCOA4/FTH1 signaling pathway, inhibition of ferritinophagy, and alleviation of oxidative stress damage.
Animals ; Electroacupuncture ; Dementia, Vascular/genetics* ; Male ; Rats ; Signal Transduction ; Humans ; Memory ; Rats, Sprague-Dawley ; Nuclear Receptor Coactivators/genetics* ; Ferritins/genetics* ; Learning ; Hippocampus/metabolism* ; Acupuncture Points

Objective To analyze the relationship between neuroticism and gastroesophageal reflux disease (GERD) using the Mendelian randomization (MR) method. Methods Exposure and outcome data were downloaded from the Integrative Epidemiology Unit (IEU) database in August 2023, including summary statistics from genome-wide association studies (GWAS) for neuroticism (n=374 323) and GERD (n=602 604). MR was conducted using the weighted median method, MR-Egger method, inverse variance weighted method, weighted mode method, and simple mode method. The causal relationship between the two was assessed using odds ratio (OR), and sensitivity analyses were performed to ensure the accuracy of the results. Results Neuroticism was associated with an increased risk of GERD [OR=1.229, 95%CI (1.186, 1.274), P<0.001]. Similarly, GERD was associated with an increased risk of neuroticism [OR=1.786, 95%CI (1.623, 1.965), P<0.001]. Conclusion There is a bidirectional causal relationship between neuroticism and gastroesophageal reflux disease.

OBJECTIVE To explore the lipid-regulating mechanism of the classic prescription Zexie Decoction on hyperlipidemia model mice.METHODS ELISA method was used to detect the four blood lipid indexes,liver function indicators and cholesterol acyltransferase levels in serum.HE and Oil Red O staining were used to determine the pathology of liver tissue.Network pharmacology was used to predict the lipid-lowering related targets of Zexie Decoction,and the GO function and KEGG pathway enrichment analyses of the intersection targets were realized.PCR chip technology was used to detect the target genes for network pharmacology screening,and qPCR and Western blot were used to detect gene and protein expression levels.RESULTS Zexie Decoction significantly regula-ted the four blood lipid indexes in hyperlipidemia model mice,improved the increase in liver damage indicators caused by high lipids,and had a reverse regulatory effect on the key enzymes HMGR and CYP7A1 of lipid metabolism and the lipid transporters ABCA1 and Apo-A1 in liver tissue.HE and Oil Red O staining showed that Zexie Decoction improved the pathological morphology of liver tissue,reduced lipid deposition in liver tissue,and significantly decreased the positive area ratio(P<0.01).The PCR chip obtained 44 re-verse-regulated genes,GO functional enrichment analysis obtained 266 entries,and KEGG pathway enrichment analysis screened 99 signaling pathways.The results of qPCR and Western blot showed that Zexie Decoction significantly downregulated the expression of PIK3CG,AKT1,and IL-6 genes(P<0.05,P<0.01),upregulated the expression of ABCG1 gene(P<0.05),downregulated PI3Kinase p110β,p-AKT(Ser473)and SREBP-1c protein expression levels(P<0.01),and reversely regulated miR21-5p(P<0.01).CONCLUSION Zexie Decoction has a significant regulatory effect on lipid metabolism in hyperlipidemia model mice and can improve liver damage caused by hyperlipidemia.Its lipid-regulating effect may be related to regulating cholesterol metabolism and transport in the body,and is closely linked to the miR21/PI3K-Akt/SREBP pathway.The lipid-regulating effect of the whole formula of Zexie Decoction is better than that of a single herb.

Distant cutaneous metastasis of primary lung squamous cell carcinoma is an exceedingly rare event,with scalp metastasis as the initial clinical presentation even rarer.Scalp skin metastases are prone to be misdiagnosed as other scalp disorders,yet their appearance signifies the deterioration and poor prognosis of lung cancer.This case report documents a female patient presenting initially with scalp folliculitis in dermatology,who was subsequently diagnosed with malignant lung tumor through radiological imaging and referred to Department of Thoracic Surgery.Pathological examination of the excised lesion from the scalp revealed distant metastasis of lung cancer.A review of similar cases reported in literature was conducted.This article aims to enhance understanding and awareness of skin metastasis in lung cancer,to emphasize the importance of this condition,and to improve early recognition and precise diagnosis.It is crucial to prevent clinical misdiagnosis and ensure ap-propriate treatment,finally leading to improve the prognosis of the patients.

With the increasing life expectancy and lifestyle changes of patients with chronic hepatitis B (CHB), the significance of comorbidities of chronic non-communicable diseases (NCDs) in disease progression and health prognosis of CHB patients is gaining prominence. This study aims to explore the association between CHB and NCDs comorbidities, focusing on the impact of common metabolism-related diseases, such as metabolic syndrome and diabetes, on the health outcomes of CHB patients. We also summarize studies on integrating the management of comorbidities in CHB patients and provide relevant recommendations for effective management. The findings of this study serve as a foundation for understanding the clinical characteristics and prevalence trends, reducing the disease burden of comorbidities among CHB patients, and establishing a comprehensive and coordinated management system for comorbidities.

Special flight missions cover vast areas,involve urgent tasks,and often require long hours,leading to visual issues for crew,especially during night flights.These problems affect flight parameters and information access.Current special aircraft cockpit displays have low technical standards and limited product sources,restricting design choices.The absence of visual ergonomics evaluation tools and methods in the aviation industry significantly contributes to the shortcomings in military aircraft cockpit design.Considering the General Specification for Airborne Liquid Crystal Displays(GJB8187-2015)and other relevant standards,this covers modern cockpit display requirements,current cockpit display status,screen light source modification technology,and visual ergonomics assessment for cockpit displays.To determine if the visual clarity,color accuracy,and other attributes of current special aircraft airborne displays during flight meet the needs for long-duration operations,and if the operational environment ensures visual comfort and ergonomics to minimize visual fatigue.We seek to enhance the evaluation of visual ergonomics satisfaction for flight crews in current special aircraft cockpits and offers new approaches to optimize cockpit display technology,reducing visual issues from prolonged screen use during flights.

Objective:To compare the efficacy of monopolar electric scissors and harmonic scalpel in Da Vinci robot-assisted distal pancreatectomy.Methods:A total of 31 patients undergoing Da Vinci robot-assisted distal pancreatectomy at the Affiliated Hospital of Xuzhou Medical University from July 2020 to December 2023 were included. There were 9 males and 22 females, aged (54.4±15.7) years. Thirty-one patients who underwent Da Vinci robot-assisted distal pancreatectomy by monopolar electric scissors were included in the monopolar electric scissors group ( n=12), with a multi-joint flexible rotating mechanical arm to complete the dissection and separation and the other were inducled in harmonic scalpel group ( n=19). Operation time, intraoperative blood loss, spleen preservation, postoperative exhaust time, postoperative hospital stay, postoperative complications and total hospitalization cost were compared between the two groups. Results:Postoperative pathology confirmed that among the 31 patients, there were 6 cases (19.4%) serous cystadenomas, 5 cases (16.1%) mucinous cystadenomas, 3 cases (9.7%) pancreatic neuroendocrine tumors, 6 cases (19.4%) solid pseudopapilloma, 5 cases (16.1%) pancreatic cysts, and 3 (9.7%) benign cystic lesions, 3 cases (9.7%) were not easily classified. All the operations were successfully completed without conversion to laparotomy or death. There were no significant differences in operation time, intraoperative blood loss, splenic preservation rate, postoperative hospital stay and total hospitalization cost between the two groups (all P>0.05). The exhaust time in the monopolar electric scissors group was (2.8±0.7) d, which was shorter than that in the harmonic scalpel group (3.6±0.7) d, and the difference was statistically significant ( t=-2.88, P=0.007). There was no postoperative bleeding in both groups. In the monopolar electric scissors group, there were 4 cases of postoperative complications, all of which were pancreatic fistula, including 2 cases of biochemical leakage and 2 cases of B-grade pancreatic fistula. In the harmonic scalpel group, 8 cases had postoperative complications, 7 cases of pancreatic fistula, including 3 cases of biochemical leakage, 4 cases of B-grade pancreatic fistula, and 3 cases of abdominal infection, which were cured after treatment. There was no significant difference in the incidence of postoperative complications between the two groups ( P=0.717). Conclusion:The application of monopolar electric scissors in Da Vinci robot-assisted distal pancreatectomy could be safe and feasible in experienced hands, which could also utilize the advantages of robot system.

Objective To systematically retrieve and integrate the best evidence of enteral and parenteral nutrition support in adult patients with severe bums.Methods 2 nursing master students who had studied evidence-based nursing systematically searched the clinical decisions,recommended practices,guidelines,expert consensuses,systematic reviews,evidence summaries and other evidences on enteral and parenteral nutrition support for adult patients with severe bums in domestic and foreign guideline networks,relevant institutional websites and databases.The retrieval time was from the establishment of the databases to April 2023.2 researchers who had obtained master's degrees and undergone systematic evidence-based training in Fudan University used the appraisal of guidelines for research and evaluation n and JBI critical appraisal tools to evaluate the methodological quality,and extracted and summarized the evidence according to the theme.Results A total of 28 articles were included,including l clinical decision,9 guidelines,3 expert consensuses,9 systematic reviews,and 6 evidence summaries.A total of 20 pieces of evidence were summarized from 6 aspects:nutritional risk screening and assessment,energy requirement calculation,timing and route of nutritional support,nutrient intake,nutritional support monitoring and effect evaluation.Conclusion The best evidence of enteral and parenteral nutrition support for adult patients with severe burns summarized in this study is more comprehensive and scientific.It is suggested that in clinical application,targeted screening should be carried out according to the promotion and hindering factors of evidence,so as to scientifically carry out nutritional support for adult patients with severe burns.